Clinical Policy Analyst: AI-Driven Coverage & Payments

Lyric

United States

On-site

USD 90,000 - 130,000

Full time

3 days ago

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Job summary

Lyric is seeking a Clinical Analyst in the United States to support the development of clinical policies and payment solutions that enable fast, accurate, and intelligent coverage decisions. This role requires deep knowledge of diagnostic testing, payment integrity, and clinical care to drive transparency and automation for health plans, providers, and laboratories.

The analyst will apply claims analytics to refine coverage criteria, evaluate supporting literature, and draft criteria considering

Qualifications

Requires a Bachelor's degree in biology, nursing, health sciences, or a related field.
5 years’ experience in direct patient care, clinical research, utilization management, or related areas.
Proficient with MS Word, MS Excel, and project management tools (JIRA or Monday.com).
Excellent communication and strong analytical skills with data-driven thinking.
Comfort with Excel formulas and pivot tables.

Responsibilities

Apply claims analytics to identify opportunities for coverage criteria and claim edit development.
Evaluate medical literature for evidence-based policy development.
Draft and maintain coverage criteria based on age, clinical presentation, and risk factors.
Present findings to peers and leadership to obtain consensus on proposed criteria.
Program rules/logic for denial of claims based on written policies.
Enter clinical content into internal tooling and support customers with cross-functional teams.